Organisational Support

The National General Practice Accreditation (NGPA) Scheme was developed in partnership with The Royal Australian College of General Practitioners (RACGP) and the Australian Commission on Safety and Quality in Health Care (the Commission).

The NGPA Scheme:

• establishes a framework for assessing general practices in accordance with the RACGP Standards for general practices and the RACGP Standards for point-of-care testing
• enhances support programs for accreditation implementation
• grants practices access to national accreditation performance data for benchmarking purposes
• includes an approval procedure for accrediting agencies responsible for assessing general practices.

The initial phase of accreditation involves selecting an accrediting agency. Following this, practices usually require 12–18 months to ready themselves for their Accreditation Assessment. Once the agency is chosen, its representative will support the practice by:

• outlining the entire process and its timeline to the practice manager
• furnishing specifics regarding accreditation criteria
• pinpointing improvement areas specific to the practice, and
• conducting the Accreditation Assessment.

See the accreditation process for general practice as a flow-chart (110kb pdf).

Everyone who works in healthcare has a part to play in creating a safe and high-quality healthcare system. Quality Improvement initiatives are one mechanism to do this.

Quality Improvement draws on a wide variety of methodologies, approaches and tools. However, many of these share some simple underlying principles, including a focus on:

• understanding the problem, with a particular emphasis on what the data tells you
• understanding the processes and systems within the organisation - particularly the care pathway - and whether these can be simplified
• analysing the demand, capacity and flow of the service
• choosing appropriate tools to bring about change, including leadership and clinical engagement, skills development, and staff and patient participation
• evaluating and measuring the impact of a change.

Quadruple aim

The quadruple aim is an evidence-based guide to identifying the outcomes healthcare providers should be aiming for with improvement activities in primary care. It divides improvements into four areas. One or more of these areas can be a target for improvement.

Palliative care is closely aligned with the quadruple aim, as the aim of palliative care and end-of-life care is to optimise the quality of life based on the needs and preferences of the older person, their family and carer(s).

Resources

The ELDAC Linkages Program was developed to help middle and upper-level managers create and sustain partnerships between aged care, primary care, and palliative care services through a continuous Quality Improvement approach to improve the care delivery. It includes information on the fundamental principles and practice of partnership development, and provides resources and tools to support your organisation to apply the evidence in practice.

It is recommended that you explore your local Primary Health Network’s resources, as many have their own local Quality Improvement resources and tools that also follow the ‘Plan-Do-Study-Act’ cycle.

Providing palliative care and advance care planning requires a multidisciplinary coordinated approach. External relationships with aged care, allied health professionals, pharmacists, dementia services and specialist palliative care services provide people receiving palliative care and their families with extended support.

The ELDAC Linkages Program provides resources and guidance on developing and sustaining partnerships with other services which provide mutual benefit and improve care outcomes.

Strategies covered include:

• Formalised agreements and plans: Formalising service partnerships, through written agreements and governance arrangements, can ensure discussion of and commitment to resource allocation, mutual responsibilities, agreed outcomes, and communication processes.
• Communication pathways: Shared and standardised documentation and communication processes support care delivery, and may include usage of common language, standardised referral forms, end-of-life pathways, agreed assessment tools, and advance care plans.
• Role clarification: This is about getting to know each other and understanding the roles and responsibilities of each member of the service partners. Who does what, when and where?
• Designated linkage worker: Appointing a staff member to act as a care and linkage coordinator across service partner settings improves access, cooperation between services, communication and continuity of care.

A practice champion is a member of your team with a strong interest in palliative and end-of-life care, who is committed to working alongside others in the practice to implement improvements in palliative care delivery.

The role of a practice champion can include completing activities such as:

• after death audits
• implementation of palliative care screening tools
• promoting the uptake of Advance Care Planning (ACP)
• promoting the uploading of ACPs to My Health Record
• coordinating learning needs assessments for GPs and Practice Nurses
• supporting education and training activities or Quality Improvement activities to build palliative care capacity, and
• keeping up to date with local palliative care programs and initiatives.

Supporting the practice champion (or linkage worker) is important to driving improvements in palliative care for your practice. You should ensure that:

• There is a clear understanding of the role of the champion between the primary care practice, aged care service and specialist palliative care.
• Management actively supports and promotes the champion role.
• All staff are aware of the designated champion and their role.
• The designated champion is appropriately resourced to carry out their role.

Some PHNs and State/Territory governments have an end-of-life or palliative care champion program that you may wish to utilise.

Like with service partnerships, engaging with a palliative care working group or collaborative (whether this is establishing a group or joining an existing one) can improve care coordination and organisational capacity to deliver safe and quality palliative care and end-of-life care.

There is limited visibility across the health system as to what palliative care activity is being delivered. This has led to fear from many practices and organisations about duplicating services and wasting what are often critical resources. Engaging in a working group or collaborative can help to bring transparency to local initiatives between services and sectors, preventing duplication and opening new opportunities to drive integrated care.

Working group membership

The number of people engaged in the working group or collaborative will depend on the size of the organisation(s) involved within the region. It may also depend on the defined purpose of the collaborative.

Potential members of a working group to consider may include:

• A client and/or family representative
• Care director or care manager
• Registered nurse/enrolled nurse
• Careworker
• Allied health representative
• Pastoral or spiritual care representative
• GP
• Primary Healthcare Network (PHN) representative
• Specialist palliative care representative
• Pharmacist

Working groups in practice

Working group activities may include:

• Establishing governance structures for implementation
• Identifying and supporting local champions
• Development and review of policies and procedures
• Review of clinical domains
• Review or development of staff training strategies
• Engagement and monitoring Quality Improvement activities
• Review of aged care standards and funding support
• Identifying and engaging key internal and external stakeholders.

Aim to meet at least monthly, and develop a standard agenda and meeting minutes with action items that are recorded. If your practice is part of a larger organisation, then coordination between working groups on organisation-wide issues, such as policies and procedures, is recommended.

Develop terms of reference that indicate working group membership, term of membership, frequency of meetings, selection of a Chair, and reporting requirements within the organisation. Record actions in the minutes from each meeting and circulate them at least one week prior to the next meeting.